Knowledge Translation for Patients With Acute Coronary Syndromes

Not Applicable

Completed

• Conditions: Acute Coronary Syndromes
• Interventions: Behavioral: knowledge translation

• Registration Number: NCT02672137
• Lead Sponsor: Montreal General Hospital

Brief Summary

Cluster randomized open-label experimental study multi-center of 24 hospitals to either knowledge translation vs usual care to improve care of patents hospitalized for acute coronary syndromes.

Detailed Description

The AMI-OPTIMA study was a cluster randomized controlled trial of 24 hospitals to one-year knowledge translation (KT) vs usual care. Prior to randomization, we reviewed charts of 100 consecutive acute coronary syndromes (ACS) patients at each participating hospital in 2009. During one year, hospitals randomized to KT completed: 1) revision of the most recent American Heart Association Guidelines of ACS management, 2) focus groups to identify and solve local care gaps, and 3)local champion team to promote evidence-based medical therapy (EBMT). At the end of 12-month of KT/usual care, we reviewed discharge prescriptions of 100 consecutive ACS patients at each participating hospital (year 2012).

EBMT was pre-defined as in-hospital anticoagulation and discharge prescription of dual anti-platelets, beta-blockers, statins, and angiotensin pathway modulating agents (for patients with impaired left ventricular systolic function). Refusal, impaired cognitive function, allergy or intolerance of patients to any of EBMT were considered valid reasons for withholding EBMT.

Study Timeline

• Study Start: 2010-01
• Primary Completion: 2015-12
• Status Verified: 2016-01
• Study Completion: 2016-01
• Study First Submitted: 2016-01-10
• Study First Submitted QC: 2016-02-02
• Last Update Submitted: 2016-02-02
• Study First Posted: 2016-02-03
• Last Update Posted: 2016-02-03

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 4604

Inclusion Criteria

Had a final discharge diagnosis of one of the following categories:

1. Myocardial infarction with ST-segment elevation
2. Myocardial infarction without ST-segment elevation
3. Unstable angina
4. Acute coronary syndromes -

Exclusion Criteria

1. Non-atherosclerotic coronary artery disease (as confirmed by coronary angiograms or other non-invasive tests such as stress test, coronary CT-scan, nuclear scans)
2. Hospital stay of less than 48 hours -

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
knowledge translation	knowledge translation	knowledge translation 12-month multi-facet intensive knowledge translation measures that include: Community of practice, local gap analysis, opinion leaders, targeted interventions, performance feedback, reminders and local formation of ACS teams.

Primary Outcome Measures

Name	Time	Method
Proportion of patients who received evidence-based medical therapy at hospital discharge (mean of 4 days)	at hospital discharge (average of 4 days)	Evidence-based medical therapy is defined as aspirin,dual-antiplaquelets, beta-blockers, statins.

Secondary Outcome Measures

Name	Time	Method
Discharge prescription of individual evidence-based medical therapy: aspirin, dual antiplatelets, beta-blockers	at hospital discharge (average of 4 days)	For each of the following medication: aspirin, dual anti-platelet, beta-blocker and statin, we calculated the proportion of patients who were prescribed the specific medication at discharge (as recorded on the discharge prescription).
Safety endpoints (mortality, reinfarction, strokes and bleeding outcomes (TIMI major and minor bleeds))	in-hospital (average of 4 days)	mortality, reinfarction, strokes and bleeding outcomes (TIMI major and minor bleeds)